Polysomnographic features differentiating disorder of arousals from sleep-related hypermotor epilepsy

Abstract

Objective The differential diagnosis between sleep-related hypermotor epilepsy (SHE) and disorders of arousal (DOA) may be challenging. We analyzed the stage and the relative time of occurrence of parasomnic and epileptic events to test their potential diagnostic accuracy as criteria to discriminate SHE from DOA. Methods Video-polysomnography recordings of 89 patients with a definite diagnosis of DOA (59) or SHE (30) were reviewed to define major or minor events and to analyze their stage and relative time of occurrence. The “event distribution index” was defined on the basis of the occurrence of events during the first versus the second part of sleep period time. A group analysis was performed between DOA and SHE patients to identify candidate predictors and to quantify their discriminative performance. Results The total number of motor events (i.e. major and minor) was significantly lower in DOA (3.2 ± 2.4) than in SHE patients (6.9 ± 8.3; p = 0.03). Episodes occurred mostly during N3 and N2 in DOA and SHE patients, respectively. The occurrence of at least one major event outside N3 was highly suggestive for SHE (p = 2*e-13; accuracy = 0.898, sensitivity = 0.793, specificity = 0.949). The occurrence of at least one minor event during N3 was highly suggestive for DOA (p = 4*e-5; accuracy = 0.73, sensitivity = 0.733, specificity = 0.723). The “event distribution index” was statistically higher in DOA for total (p = 0.012) and major events (p = 0.0026). Conclusion The stage and the relative time of occurrence of minor and major motor manifestations represent useful criteria to discriminate DOA from SHE episodes.

Seizures with paroxysmal arousals in sleep‐related hypermotor epilepsy (SHE): Dissecting epilepsy from NREM parasomnias

“…As reported for major seizures, 3,21 SPAs arise mainly from 1‐2 NREM sleep stage and SAMs mainly from 3 NREM sleep stage, confirming that also for the briefest episodes the sleep stage of occurrence represents a useful instrument to distinguish SHE seizures from DOA episodes. The results are in line with the findings of a recent study revealing that occurrence of at least one minor event during 3 NREM sleep stage is highly suggestive of DOA 25 …”

“…The results are in line with the findings of a recent study revealing that occurrence of at least one minor event during 3 NREM sleep stage is highly suggestive of DOA. 25 Surprisingly, although the IQR between SPAs (2-16) and SAMs (2-5) number per night was different between the groups, the median number of episodes per night was similar. These data underscore that the high frequency of episodes per night is not exclusive of SHE.…”

Standard procedures for the diagnostic pathway of sleep‐related epilepsies and comorbid sleep disorders: an EAN, ESRS and ILAE‐Europe consensus review

“…However, interictal and ictal scalp EEG features may be uninformative because of EEG artefacts or when seizures originate from the deep-seated cortex [65,80]. PSG may aid in the differential diagnosis (versus sleep disorders) in selected cases [10,81,82]. 1.4.2 Self-limited epilepsy with centrotemporal spikes (ECTS).…”

Commonalities and Differences in NREM Parasomnias and Sleep-Related Epilepsy: Is There a Continuum Between the Two Conditions?

“…When antiepileptic medication attenuates the occurrence of major episodes in SHE patients, sleep cycles recover a physiological architecture and a normal REM-latency due to a more solid sleep structure especially in the first part of the night (30). In contrast, the A3 phases, which are also physiologically involved in the ultradian process of sleep (46) and show increased amounts in both untreated SHE (14) and DoA (21,34), are unaffected by antiepileptic therapy (30).…”